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07/21/2004 16:41 FAX 14024714429 NEBRASKA UCC <br />5406 Departmtb <br />J'W Jane Service <br />Form 10916(c) Withdrawal of Filed Notice of Federal Tax Lien <br />(Aev. 10 -2000) <br />Area: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 135615103 <br />Lien Unit Phone: (651) 312 -80B0 <br />1 certify that the following -named taxpayer has met one or more of the elements <br />of the Internal Revenue Code (IRC) section 63230). The Internal Revenue Service <br />therefore withdraws the Notice of Federal Tax Lien for these taxes and additions. <br />The withdrawal of this notice of lien does not affect the statutory lien provided <br />by IRC section 6321; it simply relinquishes any lien priority obtained by the Internal <br />Revenue Service when the notice was fled. The proper official, in the office where <br />the Notice of Federal Tax Lien was riled on September 3 0, 2003 <br />is authorized to update the records to show the withdrawal of the notice o yen <br />feir thpcp taxes and additions. <br />Name of Taxpayer KA <br />K JOHNSON <br />Residence 1620 W JOHN ST <br />GRAND ISLAND, NE 68801 -6323 <br />COURT RECORDING INFORMATION: <br />Liber Page UC s--- Serial No. <br />n/a n/a 903296803 -1 22 >0313033 <br />unpaid Balance <br />Tax Period <br />of Assessment <br />Date of <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />(a) <br />(W <br />(c) <br />(d) <br />940 <br />12/31/2002 <br />47- 0845809 <br />09/08/2003 <br />941 <br />06/30/2002 <br />47- 0845809 <br />02/03/2003 <br />941 <br />09/30/2002 <br />47-0845809 <br />09/08/2003 <br />941 <br />12/31/2002 <br />47- 0845809 <br />06/23/2003 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 08th day of July <br />Signature <br />Car N,, 94586T <br />2004 <br />ST PAUL, MN <br />For Optional Use <br />99�04sM K <br />Fil*d: 07 <br />9006/006 <br />?cororng orrice <br />TM <br />Pas: 1 <br />K03:07 PM <br />200407202 <br />Last Day for <br />unpaid Balance <br />Refiling <br />of Assessment <br />(e) <br />(fl <br />10/08/2013 <br />389.64 <br />03/05/2013 <br />5424.36 <br />10/0B/2013 <br />6355.62 <br />07/23/2013 <br />2496.80 <br />Total 1$ 14666.42 <br />, on this, <br />Title Compliance Technical Support <br />Manager <br />n__- 4 o.._.- ...y:.... nfr—m <br />Form 10916(c) (Rev. 10 -2000) <br />